Deprivation effect on COVID-19 cases incidence and severity: a geo-epidemiological study in PACA region, France

Introduction. The spread of the COVID-19 pandemic, and its severity, is spatially heterogenous. At the individual level, the socioeconomic status (SES) profile is known to be associated with COVID-19 incidence and severity. The aim of this geo epidemiological study was to investigate the link between SES profile and potential confounders, and COVID-19 incidence and hospitalization rates, at a fine geographical scale. Methods. We analyzed COVID-19 incidence and severity during two epidemic waves between September 2020 and June 2021, in Provence Alpes Cotes d Azur, a 5 million inhabitants French region. The region is divided into sub-municipal areas that we have classified according to their SES profile. We then conducted a spatial analysis of COVID-19 indicators depending on SES profile, age structure, and health services provision. This analysis considered spatial autocorrelation between areas. Results. COVID-19 incidence rates in more deprived areas were similar to those in wealthiest ones. Hospitalization rates of COVID-19 cases in conventional care units were greater in more deprived vs wealthiest areas: Standardized Incidence Ratio (SIR) were respectively 1.34 [95% confidence interval 1.18 - 1.52] and 1.25 [1.13 - 1.38] depending on the epidemic wave. This gap was even greater regarding hospitalization rates of cases in critical care units: SIR = 1.64 [1.30 - 2.07] then 1.33 [1.14 - 1.55] depending on the epidemic wave. Hospitalization rates of COVID-19 cases in conventional care units were also greater in areas with high proportion of elderly people vs young people: SIR respectively 1.24 [1.11 - 1.38] and 1.22 [1.13 - 1.32] depending on the wave. Conclusion. Considering age structure and health services provision, a deprived SES profile is associated to a greater COVID-19 severity in terms of hospitals admissions, in conventional care units and in critical care units. This result implies targeting risk prevention efforts on these areas in pandemic situations and highlights the need to develop access to healthcare to deprived populations in anticipation of periods of crisis.

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